Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125066279 | IL |
Y | 2080P0205X | Pediatric Endocrinologist | 036.145126 | IL |
NPI | 1336533983 |
---|---|
Provider Name | Jennifer Whitehead |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2015 |
Last Update Date | 24/05/2021 |